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BACKGROUND:The short-term outcomes of pediatric digit replantation have been derived primarily from single-center/surgeon experience. The purpose of this study was to conduct a nationwide analysis of outcomes and trends of pediatric digit replantation as compared to adult patients to examine the effect of age and to revisit the age-specific indications for replantation.
METHODS:Digit replantation patients were identified in the 1999-2011 Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. Outcomes included in-hospital procedure-related and total complications, microvascular revision, amputation, and length of stay (LOS). Univariate and multivariate analyses were performed to compare pediatric and adult patients and to identify independent predictors of outcomes. The annual rate of replantation among pediatric digit amputation patients was evaluated over the study period.
RESULTS:A total of 3,010 patients who underwent digit replantation were identified, including 455 pediatric patients. Pediatric patients were most often white (63.2%), male (71.2%), privately insured (56.0%), and in the highest income quartile (29.9%). Compared to adults, children less often underwent thumb (23.1% vs. 40.2%, P<0.001) and multiple-digit (8.1% vs. 13.1%, P=0.003) replantation. For all replantations, age ≤18 years was associated with a lower likelihood of suffering a total complication (odds ratio (OR) 0.66, P=0.006), requiring amputation (OR 0.62, P<0.001), and experiencing LOS >5 days (OR 0.77, P=0.019), after adjusting for comorbidity, amputation severity, digit type, number of replantations, and hospital characteristics. Similar associations were observed between patient age and replantation outcomes for single-finger replantations. The rate of pediatric replantation (range 16 to 27%) remained consistent through the study period (incidence rate ratio 0.98, P=0.06).
CONCLUSIONS:The rate of pediatric replantation has been relatively low, being 27 % at most in a given year. Importantly, short-term outcomes are better in children than for adults, supporting the indication to perform replantation in this age group when the surgeon feels that replantation is feasible and safe.